The National Abortion Federation imposes new abortion restrictions

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New restrictions from one of the country’s largest abortion-funding organizations could add new obstacles for many patients in anti-abortion states seeking the procedure elsewhere.

Since Roe v. calf was overturned in June, patients have flooded clinics in states where abortion is legal – many travel long distances to obtain one medical abortion, a two-part regimen containing mifepristone and misoprostol. These patients usually take mifepristone at the clinic before going home with the misoprostol to take between 24 and 48 hours later.

The National Abortion Federation and its NAF Hotline Fund will now require patients receiving their funding to both take abortion pills in a state where abortion is legal, according to emails sent Aug. 22 and by the Washington Post were received. The nonprofit, which is largely backed by billionaire Warren Buffett, helped fund at least 10 percent of all abortions in the United States in 2020. The new rules could affect thousands of patients a year, providers say.

Patients who need abortion financing can either call the NAF hotline or request financial assistance at a clinic authorized to provide assistance. Under new NAF regulations, effective August 29, patients whose procedures are funded by the NAF must now confirm this to clinical staff that they do not take their second pill in a state where abortion is illegal.

According to an email to abortion providers from NAF Hotline Fund Operations Director Chloe Hanson Hebert, clinics will only have to impose the NAF’s new restrictions on patients who receive NAF funding. The restrictions will disproportionately hit poor women and women of color, several vendors said.

These new restrictions go beyond what is specifically required by the abortion bans enacted since then roe was reversed. The various prohibitions in anti-abortion states prohibit providers from performing abortions within state lines, but do not prevent providers elsewhere from prescribing pills to patients outside the state who they know will return home.

The NAF did not respond to a request for comment on this story. But in previous interviews, NAF officials have said they are struggling to adapt to the changing legal landscape to protect the organization and the patients they serve. This recent policy change underscores the impact of the Dobbs ruling, which has created widespread uncertainty about how state laws are enforced, even towards providers and physicians in states where abortion is legal.

Some abortion providers and advocates say the restrictions are unnecessary and onerous for patients who already face major barriers to abortion care following the Supreme Court decision that left 1 in 3 women unable to access the procedure. The NAF’s restrictions mean that out-of-state patients traveling for a medical abortion may have to spend up to two extra nights in a hotel, in addition to the additional cost of food and childcare.

“It’s hard enough to make that journey, even if you return home the same day,” said a New Mexico abortion provider regulated by the NAF. Like others interviewed for this story, the provider spoke on condition of anonymity because about 50 percent of its patients rely on NAF funding.

“Now my patients are unnecessarily further regulated by a so-called ally.”

The new NAF restrictions, the vendor added, “look like something an anti-abortion advocate would write.”

Abortion is now illegal in these states. See where laws have changed.

With 7 million dollars annual budget, the National Abortion Federation, works with hundreds of clinics across the country — including independent clinics and clinics affiliated with Planned Parenthood — providing staff training and safety support, among other services. NAF staff regularly visit member hospitals to “ensure they are providing the highest quality care,” the agency said NAF website.

In a mid-July interview with The Post, NAF chief operating officer Veronica Jones acknowledged that the Supreme Court decision changed the abortion landscape. “Failing to incorporate this new reality into our decision-making would jeopardize our entire operations and ultimately leave hundreds of thousands without access to healthcare,” she said, adding that the NAF has killed 3,000 people in access to healthcare in the weeks since the Supreme Court Abortions have helped judgment.

Medical abortions now account accounts for more than 50 percent of abortion procedures in the United States, according to NAF estimates and data from the Guttmacher Institute, a research organization that supports abortion rights — with many patients choosing to take pills rather than undergo surgery.

While both abortion pills — mifepristone and misoprostol — can be taken at the same time if the misoprostol is taken vaginally, this method is far less popular and would make immediate travel risky, providers say, since the patient could wean the pregnancy on her way home.

With abortions now banned or mostly banned in 15 states, organizations like the NAF that offer abortion funding play an even more important role in helping patients access medical care. In addition to the price of the procedure itself, which costs an average of $500 in the first trimester, some patients in anti-abortion states must travel to obtain a legal abortion—sometimes hundreds of miles.

Under the new rules, providers must certify that the patient either took the pills at the clinic or promised to take both in a state where abortion is legal up to the point the patient received treatment.

“That’s a lot of patients [traveling out of state] without telling their community, friends or partners,” said an abortion provider who works in Kansas, where abortion remains legal up to 22 weeks gestation. “The poorest and most disenfranchised patients need to organize even more childcare, take time off work and change their story about what’s going on.”

Some abortion providers have grown increasingly skeptical of the NAF since the organization threatened to withdraw funding from any Texas clinic that does not fully comply with the state’s strict ban that went into effect last fall, several abortion providers said, some of them during abortion in Texas was still legal there. This decision, first reported by Jezebelprevented legal challenges that could have resulted in an injunction and allowed abortions to continue as usual.

Some abortion providers say they understand the NAF’s decision.

When she heard about the new guidelines, Michigan abortion provider Renee Chelian wasn’t surprised: A few weeks after the Supreme Court decision, her clinics required patients to take both pills before leaving the state. Chelian and her collaborators drafted a form for patients to sign and promised to start and finish their medical abortion in Michigan.

Chelian said she was more concerned about legal liability after an Ohio pharmacist called to inquire about pain medications her clinic had prescribed for an abortion patient living in Ohio, where abortion is now banned after six weeks of pregnancy. The pharmacist wanted to know if the patient had miscarried.

“We must do everything we can to ensure that NAF is protected, our doctors are protected and our patients are protected,” Chelian said.

“It’s post-roe,” she added. “Nothing is certain anymore.”

Christopher Rowland contributed to this report.

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